| NEW YORK, June 17
NEW YORK, June 17 When I signed up my kids for
therapy after my divorce, I made some financial mistakes. The
biggest was choosing an out-of-network provider, over one who
takes my insurance.
Instead of a simple $20 co-pay, I spend $150 out of pocket
and get 70 percent of it reimbursed, which works out to about
$1,000 more over a school year. In contrast, I have a friend
whose child's therapy sessions require no co-pays at all.
In this way, mental health coverage has a lot in common with
airline pricing, where seats on the same plane may sell at many
different price points.
Overall, Americans spend about $2,100 per child for
healthcare, according to the Health Care Cost Institute's report
for 2007-2010. And the use of mental health services by children
jumped 24 percent over that period, the report says.
At the same time, nearly half of all psychiatrists no longer
take insurance, according to JAMA Psychiatry, with a similar
portion of psychologists now only accepting private payment.
Add to that an overall shortage of providers - there are
8,700 child and adolescent psychiatrists, compared to about
50,000 for adults, according to Dr. Paramjit Joshi, division
chief of psychiatry and psychology at Children's National Health
System - and you have a supply and demand problem that makes
cost a real issue for parents.
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Finding a provider in your area may be easy enough, but
finding one whose availability suits your child's schedule could
be downright impossible.
That's why I went the private-pay route. My area of Brooklyn
has no shortage of doctors on my plan, but after calling a dozen
and finding that an after-school slot would entail a months-long
wait, I went with a personal recommendation.
To avoid the appointment runaround, lean on your plan's
customer service department to make calls for you, says Dr. Ian
Shaffer, executive medical director for behavioral health for
Healthfirst, a New York health plan.
Need a therapist with a specialty? You may be able to get
that provider covered if you ask, Shaffer says.
He cited a case where the family wanted a therapist who
shared their ethnic heritage, and had been recommended someone
who charged an eye-popping $350 a visit. Healthfirst found them
another therapist with the same credentials, and covered the
My friend with the zero co-pay has insurance through the
state's child health plan, but enrolment in the plan is possible
only if you don't have access to other coverage.
Most people who are on health plans through their workplace
don't have payment wiggle room, but you can ask individual
providers what they can do to help, especially if you have a
Many private-pay therapists have sliding scales based on
income; others have lower fees if you work with a trainee. Since
the latter are supervised grad students, "it's like getting two
doctors for the price of one, says Clair Mellenthin, director of
child and adolescent services at Wasatch Family Therapy in Salt
Lake City, Utah.
Also check state resources to help pay for therapy,
especially if treatment is needed for some kind of trauma
following a crime. Many states have victim funds, says
Therapy can seem like an endless process, so parents need to
make sure it's staying on track, says Mitchell Prinstein, a
professor of psychology at the University of North Carolina at
After the initial evaluation, make sure you have a clear
treatment plan and markers to help you figure out if your child
is making progress. If there's little improvement, get a second
opinion, Prinstein says. And don't feel bad about moving on if
the therapist is not the right fit.
For ongoing treatment, it's important to make sure the
insurance company is not crimping your coverage.
Even though parity clauses in the new healthcare laws say
you should get as many sessions as you need, that's not always
After a while, insurers may start saying the sessions are no
longer medically necessary. This is especially true if your
child has a serious ongoing problem, says Alan Nessman, senior
special counsel for the American Psychological Association.
Any denial of coverage can be costly.
Joe Hoyle's bill for one month of his daughter's treatment
for a serious illness was $125,000 after his insurance company
denied the claim (he negotiated a lower payment with the
hospital directly). To obtain ongoing coverage, Hoyle and his
wife, who live in Virginia, got her on Medicaid.
"They say they cover things, but then they get to decide
when things are 'stable,'" he says.
Hoyle urges parents to get care early for their children to
try to head off bigger problems.
"You can go along for 10 or 12 years and think your kid is
just quirky, then almost literally overnight, it can go to
full-blown mental illness," he says. "You hate to talk about it,
but people need to know because state governments need to do
more to help people out."
(Editing by Lauren Young and Bernadette Baum)